(1127) Risk factors for postnatal cerebrospinal fluid diversion after percutaneous fetoscopic open spina bifida repair

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: The aim of this study was to assess the rate and risk factors for cerebrospinal (CSF) diversion at 1 year of life after percutaneous fetoscopic repair of open spina bifida (OSB).

Study Design: This is a prospective study of patients who underwent percutaneous fetoscopic OSB repair from February 2019 to July 2022. The decision to offer CSF diversion was based on postnatal magnetic resonance imaging and clinical findings. Preoperative, operative, and neonatal characteristics were examined as predictors for a CSF diversion procedure (ventriculoperitoneal shunt or endoscopic third ventriculostomy) within the first 12 months of life, using bivariate analysis and multiple logistic regression models. Continuous variables are presented as mean ± standard deviation.

Results: 57 patients were enrolled; of these, 17 were < 12 months old and 1 had an incomplete surgery, leaving 39 study patients. Any degree of hindbrain herniation (HBH) reversal was noted in 35 (89.7%), and complete HBH reversal in 19 (48.7%). CSF diversion by 12 months of age was required in 13 cases (33.3%). Patient characteristics are compared in the Table. In bivariate analysis (p < 0.05), either fetal ventricular measurement >= 15 mm prior to surgery and lack of complete hindbrain HBH reversal at neonatal assessment were associated with the need for a CSF diversion procedure. Logistic regression showed that cases with a lateral ventricle >=15 mm were nearly 11 times more likely to have CSF diversion (OR 10.93, 95%CI 1.71-69.94, p = 0.0116), and cases lacking complete HBH reversal were > 6 times more likely than cases of complete reversal to have CSF diversion (OR 6.61, 95%CI 1.11-39.23, p=0.0378).

Conclusion: Percutaneous fetoscopic repair of OSB was associated with a 33% risk of postnatal CSF diversion at 1 year of life. Risk factors for CSF diversion included preoperative ventriculomegaly >= 15 mm and lack of complete HBH reversal at birth.

Primary & Presenting Author(s)

Ramen H. Chmait, MD (he/him/his)
Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
University of Southern California
Los Angeles, California, United States

Coauthor(s)

JC
Jason Chu, MD, MSc
Assistant Professor of Neurological Surgery
Keck School of Medicine, University of Southern California
Los Angeles, California, United States
AV
Alexander L. Van Speybroeck, MD, MPH
Associate Professor of Clinical Pediatrics
Keck School of Medicine, University of Southern California
Los Angeles, California, United States
HP
Huyen Q. Pham, MD
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California
Los Angeles, California, United States
AL
Arlyn Llanes, BS, MHA, RN
Keck School of Medicine, University of Southern California
Los Angeles, California, United States
LK
Lisa M. Korst, MD, PhD
Childbirth Research Associates
North Hollywood, California, United States
EK
Eftichia V. Kontopoulos, MD, PhD
USFetus Research Consortium
Miami, Florida, United States
RQ
Ruben A. Quintero, MD
USFetus Research Consortium
Miami, Florida, United States